title: Telmisartan in incipient and overt diabetic renal disease.
abstract: BACKGROUND
  Renal dysfunction can be regarded as a continuum that extends from endothelial dysfunction to microalbuminuria, macroalbuminuria, end-stage renal disease and ultimately to death. All stages of this continuum are associated with progressively increasing cardiovascular risk. Preventing the development and progression of kidney disease requires rigorous management of blood pressure. Due to the important role of the renin-angiotensin system in the pathogenesis of diabetic renal disease, agents that inhibit this system are recognized as first-line therapy, offering both effective blood pressure lowering and direct actions on the kidney. This review examines the effects of the angiotensin II receptor blocker telmisartan on renal dysfunction.
  
  
  METHODS
  Renal studies with telmisartan were obtained from a search on Medline and from the authors' literature sources.
  
  
  RESULTS
  Telmisartan provides renal benefit at all stages of the renal continuum in patients with type 2 diabetes. It improves endothelial function in patients with normoalbuminuria, delays the progression to overt nephropathy in patients with microalbuminuria and reduces proteinuria in patients with macroalbuminuria. Effectiveness of telmisartan is comparable to angiotensin-converting enzyme inhibitors, but with greater tolerability. The effect of telmisartan on protein excretion in diabetic nephropathy appears to be better than that of losartan and equivalent to that of valsartan. In the ONTARGET study, telmisartan provided similar cardiovascular protection to ramipril in a broad at-risk population that included patients with diabetes, while being better tolerated and having fewer treatment discontinuations.
  
  
  CONCLUSIONS
  The effects of telmisartan on kidney function support its use in patients with microalbuminuria or overt diabetic nephropathy.
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen - Germany.
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: George
authors.initials: G
authors.lastname: Bakris
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000419:Albuminuria / Q000188:drug therapy / Q000503:physiopathology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D001565:Benzoates / Q000494:pharmacology / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000503:physiopathology; D000077333:Telmisartan; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D000077333:Telmisartan